Provider Demographics
NPI:1114380045
Name:PASTOR, THOMAS JAMES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:PASTOR
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:EAST WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04234-0390
Mailing Address - Country:US
Mailing Address - Phone:207-645-9522
Mailing Address - Fax:
Practice Address - Street 1:1445 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST WILTON
Practice Address - State:ME
Practice Address - Zip Code:04234
Practice Address - Country:US
Practice Address - Phone:207-645-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN44311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice